Digestive System

Functions
1. Digestion
2. Absorption
3. Defecation

2 Parts
A. Alimentary Canal/GIT – hollow muscular tubes
B. Accessory Digestive Organs – assist the alimentary canal in terms of digesting food

I. Accessory Digestive Organs

1. Salivary Glands
1. Secrete saliva into the mouth (buccal)
2. Composition:
a. 99.5% H2O
b. 0.5% solutes (Sodium, Potassium, Chloride)
c. Immunoglobulin A (Microorganism Killer)
d. Normal: 1,000-1,500 mL
3. 2 Types of Protein
a. Serous Secretion – starch digesting enzyme “Salivary amylase/ptyalin”
b. Mucus Secretion – Mucin: adds moisture to the food + binds the food together = bolus
4. 3 Glands
a. Parotid Gland – anterior & inferior to the ears; between the skin & masseter
i. Inflammation of Parotid Gland: Mumps
ii. Largest Salivary Gland (Past Board Exam Question)
b. Submandibular Gland – beneath the base of the tongue in the posterior part of the floor of the mouth
c. Sublingual Gland – superior to the submandibular gland
5. Controlled by ANS
a. Para - ↑ production of saliva
b. Sympa - ↓ production of saliva

2. Teeth “Dentes”
1. 2 Sets
a. Deciduous Teeth
i. AKA: Milk/Temporary/Baby Teeth
ii. 20 in Number
iii. In Each Jaw
1. 2 Canine
2. 4 Incissors
3. 4 Molars
iv. First teeth to erupt: lower central incisors “6 months”
v. All deciduous Teeth gone between 6-12 y/o
b. Permanent Teeth
i. 32 in number
ii. In each Jaw
1. 2 canines
2. 4 incisors
3. 4 premolars
4. 6 molars

3. Tongue
1. floor of the Mouth
2. Extrinsic Muscles: movement of the tongue side to side, in and out
a. Blood Supply: Lingual A.

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b. Innervated by CN12 Hypoglossal N.

3. Intrinsic Muscles: altering the shape of the tongue during speech
a. Blood Supply: Lingual A.
b. Innervated by CN12 Hypoglossal N.
4. Taste buds: receptor for taste

4. Pancreas
1. Both an exocrine & endocrine gland
2. Exocrine Fxn: produces enzymes
3. Endocrine Fxn: produces hormones
4. Location: greater curvature of the stomach
5. Parts: Head, Neck, Body, Tail
6. (+) Pancreatic Juice: contains 3 Enzymes
a. Carbohydrate Digesting Enzyme: Pancreatic Amylase
b. Protein digesting Enzyme: Trypsinogen
𝑇𝑟𝑦𝑝𝑠𝑖𝑛𝑜𝑔𝑒𝑛 𝑒𝑛𝑡𝑒𝑟𝑜𝑘𝑖𝑛𝑎𝑠𝑒 𝑇𝑟𝑦𝑝𝑠𝑖𝑛
𝐼𝑛𝑎𝑐𝑡𝑖𝑣𝑒 𝐹𝑜𝑟𝑚
−> 𝑏𝑟𝑢𝑠ℎ 𝑏𝑜𝑟𝑑𝑒𝑟 𝑣𝑖𝑙𝑙𝑖 + 𝐴𝑐𝑡𝑖𝑣𝑎𝑡𝑜𝑟
−> 𝐴𝑐𝑡𝑖𝑣𝑒 𝐹𝑜𝑟𝑚
c. Triglyceride Digesting Enzyme: pancreatic lipase (Lip-: lipid; -ase: break down)
d. Normal Amount: 1200-1500 mL

7. Pancreatic Duct – “Duct of Wirsung”

8. Smaller Pancreatic Duct/Accessory Duct – “Duct of Santorini”
a. Larger Pancreatic Duct – connects to Common Bile Duct; LPD + CBD = Hepatopancreatic Ampulla +
Sphincter of Oddi
9. Trypsinogen should be active at the level of the pancreas; if it becomes Typsin at the pancreas it leads to
pancreatitis
10. Relaxation of Sphincter of Oddi (Sphincter is Always closed)
b. Release of Cholecystokinin
c. Peristaltic Wave in CBD
d. Intestinal Wave

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5. Liver
1. Heaviest Gland
2. 2nd Largest Organ
3. Functional Unit: LOBULE
a. Hepatocytes – produce bile
b. Bile – Emulsification of Fats
i. Composition: H2O, cholesterol, bile salts, bile pigments
ii. Bile Pigments color: yellow to olive green
iii. Normal Amount: 800-1000 mL

6. Gallbladder
1. Storage of bile
2. Inferior to the liver

CHD – Common Hepatic Duct; formed by (R) Hepatic and (L) Hepatic Duct
Cystic Duct + CHD joins together = Common Bile Duct
CBD + LPD = Hepatopancreatic Ampulla + Sphincter of Oddi

II. Alimentary Canal

1. Mouth
1. Buccal/Oral Cavity
a. Lateral Wall: Cheeks
b. Anterior portion of Roof: Hard Palate
c. Posterior Portion of Roof: Soft Palate
d. Floor of the Mouth: tongue

2. Pharynx “Throat”
1. 3 parts
a. Nasopharynx – only for respiration
b. Oropharynx – Both respiration & Digestion
c. Laryngopharynx – Both respiration & Digestion
2. Deglutition “Act of Swallowing”
a. Voluntary Stage
i. Movement of Bolus into the oropharynx
b. Pharyngeal Stage “Fastest Stage”
i. receptors in the oropharynx will send signals to the deglutition center
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1. Lower Pons and Medulla Oblongata; if you can only choose 1, pick MO; if you can choose
2, pick both
ii. Deglutition Center
1. Soft Palate + Uvula = moves superiorly to close off the nasopharynx
2. Larynx (Voice box) = moves forward + upward*
3. Epiglottis = backward + downward*
a. *Larynx and Epiglottis moves to widen the opening of esophagus
iii. Breathing is interrupted for 2-3 seconds
c. Esophageal Stage
i. Movement of bolus into the esophagus

3. Esophagus
1. 25 cm long
2. Composed of smooth muscle
3. (-) Digestion enzyme
4. (-) absorption
5. Fxn: passageway of bolus to the stomach
6. 2 Sphincters
a. Upper Esophageal Sphincter
b. Lower Esophageal Sphincter/Cardio-esophageal Sphincter
i. PEAT: “If the LES is not closing the conditions is?” – Gastroesophageal Reflux Disease (GERD); (+)
Chest Pain
ii. GERD – relieves by Antacids

4. Stomach
1. “C” / “J” Shape
2. Storage of Food
3. Holds 4 liters
4. Parts of the Stomach
a. Cardia: opening portion
b. Fundus: broad portion
c. Body: central portion
d. Pylorus: terminal portion
i. Pyloric Sphincter: between Pylorus and Duodenum

5. 2 Tubular Glands
a. Gastric Gland
i. Mucus Neck Cell – produces mucus
ii. Chief Cell – produces pepsinogen -> pepsin: protein digestive enzyme
iii. Parietal Cell – intrinsic factor (for the reabsorption of VitB12 – absorbed at the Ileum) +
Hydrochloric Acid

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1. If you have poor reabsorption of VitB12 leads to Pernicious Anemia

2. Hydrochloric Acid: activates the pepsinogen into pepsin
3. Hydrochloric Acid: (N) 2000-3000 mL
b. Pyloric Gland
i. G-Cell – produces hormone “Gastrin” (G-Cell loves Gastrin)
1. Gastrin: for the maturation, growth, development of gastric gland
2. ↑ Gastrin - ↑ Gastric Juice
a. Increases with Coffee and Chocolate. Make sure to eat something before eating
chocolate/drinking coffee (Hyper acidity)
3. Inhibition for Gastrin – Somatostatin

5. Small Intestine
1. Longest alimentary canal
2. Major digestive organ
3. Major Evens of Absorption
4. Parts: Duodenum, Jejunum, Ileum
5. Hormones
a. Cholecystokinin – Stimulates contraction of Gall Bladder
b. Secretin – Stimulation of Pancreas; Liver
6. Chyme “White Cream”
a. (+) Enterogastric Reflex: tightening of pyloric sphincter
b. Release of Chyme: 2-3 teaspoons
7. Journey of Chyme via looping coils of Small Intestine takes
a. Well Balanced Mean: 4-6 hours
b. After Fatty Meal: 5-6 hours

6. Large Intestine
1. Largest alimentary canal
2. Function: haustral contraction
3. Parts: Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, anus
a. Stretched Rectum activates Defecation reflex
4. (+) ileocecal sphincter: between Ileum and Cecum
5. Undigested food can last up to 72 hours in Large Intestine
6. Good Bacteria lives in the Large Intestine which produces – (+) methane gas – 500 mL
a. 500 mL same as Tidal Volume
b. Kamote and Carbohydrates make great Methane
7. Board Exam Question: What is responsible for the “Golden Brown Color” of stool? A – Stercobilin

Case Study
 (+) Distention of Colon – Megacolon/Hirschsprung Disease
 (+) Proctitis – inflammation of rectum

Neural Control for GIT

Enteric Nervous System
1. Myenteric/Auerbach Plexus – movements & contractions for GIT
2. Submucosa/Meissner’s Plexus – secretions & blood flow for GIT

Carbohydrates
1. Mono + saccharides – Simple Sugar
a. Can penetrate cell membrane
b. Ex: glucose, fructose, ribose, galactose
2. Di + saccharides – Double Sugar
a. Cannot penetrate cell membrane; needs to break down into monosaccharides first
b. Ex: Maltose (Beer Sugar) = Glucose + Glucose
c. Ex: Sucrose (Table Sugar) = Fructose + Glucose
d. Ex: Lactose (Milk Sugar) = glucose + galactose
3. Poly + Saccharides – Many Sugar
a. Cannot penetrate cell membrane; needs to break down into monosaccharides first
b. Ex: Starch from Root Vegetables (carrots, potatoes), Grain products
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c. Ex: Glycogen – animal Tissue such as liver

Digestion
𝐼𝑛 𝑡ℎ𝑒 𝑚𝑜𝑢𝑡ℎ 𝑠𝑡𝑎𝑟𝑐ℎ 𝑀𝑎𝑙𝑡𝑜𝑠𝑒
 : −>
(𝑆𝑎𝑙𝑖𝑣𝑎𝑟𝑦 𝐴𝑚𝑦𝑙𝑎𝑠𝑒) (𝑃𝑜𝑙𝑦𝑠𝑎𝑐𝑐ℎ𝑎𝑟𝑖𝑑𝑒) (𝐷𝑖𝑠𝑎𝑐𝑐ℎ𝑎𝑟𝑖𝑑𝑒)
𝐼𝑛 𝑡ℎ𝑒 𝑠𝑡𝑜𝑚𝑎𝑐ℎ
 (𝑃𝑒𝑝𝑠𝑖𝑛)
: 𝑃𝑟𝑜𝑡𝑒𝑖𝑛 → 𝐿𝑎𝑟𝑔𝑒 𝑃𝑜𝑙𝑦𝑝𝑒𝑝𝑡𝑖𝑑𝑒
 𝐼𝑛 𝑡ℎ𝑒 𝑆𝑚𝑎𝑙𝑙 𝐼𝑛𝑡𝑒𝑠𝑡𝑖𝑛𝑒
o 𝑇𝑟𝑦𝑝𝑠𝑖𝑛 + 𝑙𝑎𝑟𝑔𝑒 𝑝𝑜𝑙𝑦𝑝𝑒𝑝𝑡𝑖𝑑𝑒 = 𝑝𝑒𝑝𝑡𝑖𝑑𝑒
 Peptide the smallest form of protein
o (𝑃𝑎𝑛𝑐𝑟𝑒𝑎𝑡𝑖𝑐 𝐿𝑖𝑝𝑎𝑠𝑒 + 𝐵𝑖𝑙𝑒) + 𝑇𝑟𝑖𝑔𝑙𝑦𝑐𝑒𝑟𝑖𝑑𝑒 = 𝑀𝑜𝑛𝑜𝑔𝑙𝑦𝑐𝑒𝑟𝑖𝑑𝑒 + 𝐴𝑚𝑖𝑛𝑜 𝐴𝑐𝑖𝑑 + 𝐹𝑎𝑡𝑡𝑦 𝐴𝑐𝑖𝑑
o [𝑃𝑎𝑛𝑐𝑟𝑒𝑎𝑡𝑖𝑐 𝐴𝑚𝑦𝑙𝑎𝑠𝑒 + 𝐵𝑟𝑢𝑠ℎ 𝐵𝑜𝑟𝑑𝑒𝑟 𝑉𝑖𝑙𝑙𝑖 (𝑆𝑢𝑐𝑟𝑎𝑠𝑒 + 𝐿𝑎𝑐𝑡𝑎𝑠𝑒 + 𝑀𝑎𝑙𝑡𝑎𝑠𝑒)] =
−> −>
 𝑀𝑎𝑙𝑡𝑎𝑠𝑒 𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝑀𝑎𝑙𝑡𝑜𝑠𝑒 𝑤ℎ𝑖𝑐ℎ 𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝑖𝑛𝑡𝑜 𝑔𝑙𝑢𝑐𝑜𝑠𝑒, 𝑔𝑙𝑢𝑐𝑜𝑠𝑒
−> −>
 𝐿𝑎𝑐𝑡𝑎𝑠𝑒 𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝐿𝑎𝑐𝑡𝑜𝑠𝑒 𝑔𝑙𝑢𝑐𝑜𝑠𝑒, 𝑔𝑎𝑙𝑎𝑐𝑡𝑜𝑠𝑒
𝑤ℎ𝑖𝑐ℎ 𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝑖𝑛𝑡𝑜
−> −>
 𝑆𝑢𝑐𝑟𝑎𝑠𝑒 𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝑆𝑢𝑐𝑟𝑜𝑠𝑒 𝑔𝑙𝑢𝑐𝑜𝑠𝑒, 𝑓𝑟𝑢𝑐𝑡𝑜𝑠𝑒
𝑤ℎ𝑖𝑐ℎ 𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝑖𝑛𝑡𝑜

Four Quadrants of the Abdomen

Right Upper Quadrant Left Upper Quadrant
(R) Kidney (L) Kidney
Liver Stomach
Gallbladder Spleen
Pancreas (Head, Neck) Pancreas (Body, Tail)
Right Lower Quadrant Left Lower Quadrant
C ecum
Sigmoid Colon
A ppendix
R ight Ovary Left Ovary

9 Regions of the Abdomen

Right Left
Hypochondrium Epigastric Region Hypochondrium
Flank Umbilical Region Flank
Inguinal Region Suprapubic Region Inguinal Region

Organ Pain
1. Stomach
a. Localized Pain – Epigastric Region
b. Referred Pain – (R) Shoulder, Lateral Border of (R) Scapula
2. Small Intestine
a. Localized Pain – Umbilical Region
b. Referred Pain – lower back area
3. Large Intestine/Colon
a. Localized Pain – Suprapubic Region
b. Referred Pain – Sacrum
4. Liver & Gallbladder
a. Localized Pain – (R) Upper Quadrant/(R) Hypochondrium
b. Referred Pain – (R) Shoulder, Shoulder Blades
5. Spleen (Past Boards: Spleen is first to rupture, usually d/t trauma)
a. Localized Pain – (L) Upper Quadrant/(L) Hypochondrium
b. Referred Pain – (L) Shoulder
6. Pancreas
a. Localized Pain – (L) Upper Quadrant/(L) Hypochondrium
b. Referred Pain – (L) Shoulder

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